Participation in scheduled asthma follow-up contacts and adherence to treatment during 12-year follow-up in patients with adult-onset asthma

BACKGROUND: Poor treatment compliance is a common problem in the treatment of asthma. To our knowledge, no previous long-term follow-up studies exist on how scheduled asthma follow-up contacts occur in primary health care (PHC) versus secondary care and how these contacts relate to adherence to medication and in participation to further scheduled asthma contacts. The aim of this study was to evaluate occurrence of scheduled asthma contacts and treatment compliance in PHC versus secondary care, and to identify the factors associated with non-participation to scheduled contacts. METHODS: Patients with new adult-onset asthma (n = 203) were followed for 12 years in a real-life asthma cohort of the Seinäjoki Adult Asthma Study (SAAS). The first contacts were mainly carried out in secondary care and therefore the actual follow-up time including PHC visits was 10 years. RESULTS: A majority (71%) of the patients had ≥ 2 scheduled asthma contacts during 10-year follow-up and most of them (79%) mainly in PHC. Patients with follow-up contacts mainly in PHC had better adherence to inhaled corticosteroid (ICS) medication during the whole 12-year period compared to patients in secondary care. In the study population, 29% of the patients had only 0-1 scheduled asthma contacts during the follow-up. Heavy alcohol consumption predicted poor participation in scheduled contacts. CONCLUSIONS: Patients with mainly PHC scheduled asthma contacts were more adherent to ICS medication than patients in the secondary care. Based on our results it is necessary to pay more attention to actualization of asthma follow-up visits and systematic assessment of asthma patients including evaluation of alcohol consumption. Trial registration Seinäjoki Adult Asthma Study is retrospectively registered at www.ClinicalTrials.gov with identifier number NCT02733016. Registered 11 April 2016.publishedVersionPeer reviewe

Documentation of smoking in scheduled asthma contacts in primary health care : a 12-year follow-up study

Smoking among asthmatics is common and associates with poorer asthma control, more rapid lung function decline and higher health care costs in dose-dependent manner. No previous real-life studies exist, however, on how smoking status and pack-years are documented in scheduled asthma contacts in primary health care (PHC) during long-term follow-up, and how often patients are advised to quit smoking. In this real-life 12-year follow-up study, we showed that out of all scheduled PHC asthma contacts (n = 603) smoking was mentioned only in 17.2% and pack-years only in 6.5%. Smoking data was not recorded even once in 70.9% of never smokers, 64.7% of ex-smokers and 27.3% of current smokers. Smoking including pack-years were mentioned more often if nurse took part on the scheduled contact. For current smokers, smoking cessation was recommended only in 21.7% of their scheduled contacts. Current smokers used more antibiotics and had more unscheduled health care contacts during follow-up.publishedVersionPeer reviewe

Multisite pain@Work – liikuntaelimistön monikipuisuuden vaikutukset työkykyyn

Tutkimuksen päätavoitteena oli selvittää tuki- ja liikuntaelimistön monikipuisuuden vaikutuksia työkykyyn, käyttäen työkyvyn osoittimina sairauspoissaoloja ja siirtymistä työkyvyttömyyseläkkeelle. Lisäksi tutkittiin monikipuisuuden esiintyvyyttä ja sen riskitekijöitä

The severity of Puumala hantavirus induced nephropathia epidemica can be better evaluated using plasma interleukin-6 than C-reactive protein determinations

<p>Abstract</p> <p>Background</p> <p>Nephropathia epidemica (NE) is a Scandinavian type of hemorrhagic fever with renal syndrome caused by Puumala hantavirus. The clinical course of the disease varies greatly in severity. The aim of the present study was to evaluate whether plasma C-reactive protein (CRP) and interleukin (IL)-6 levels associate with the severity of NE.</p> <p>Methods</p> <p>A prospectively collected cohort of 118 consecutive hospital-treated patients with acute serologically confirmed NE was examined. Plasma IL-6, CRP, and creatinine, as well as blood cell count and daily urinary protein excretion were measured on three consecutive days after admission. Plasma IL-6 and CRP levels higher than the median were considered high.</p> <p>Results</p> <p>We found that high IL-6 associated with most variables reflecting the severity of the disease. When compared to patients with low IL-6, patients with high IL-6 had higher maximum blood leukocyte count (11.9 <it>vs </it>9.0 × 10⁹/l, <it>P </it>= 0.001) and urinary protein excretion (2.51 <it>vs </it>1.68 g/day, <it>P </it>= 0.017), as well as a lower minimum blood platelet count (55 <it>vs </it>80 × 10⁹/l, <it>P </it>< 0.001), hematocrit (0.34 <it>vs </it>0.38, <it>P </it>= 0.001), and urinary output (1040 <it>vs </it>2180 ml/day, <it>P </it>< 0.001). They also stayed longer in hospital than patients with low IL-6 (8 <it>vs </it>6 days, <it>P </it>< 0.001). In contrast, high CRP did not associate with severe disease.</p> <p>Conclusions</p> <p>High plasma IL-6 concentrations associate with a clinically severe acute Puumala hantavirus infection, whereas high plasma CRP as such does not reflect the severity of the disease.</p

Continuing Vocational Training for Teachers in Beauty and Hair Care : Teachers Act as Active Developers of their Work and Engage in Transferring Good Practices to their Students

This paper describes the experiences of students and organizers of the Hair and beauty care, the prevention of health hazards (HIKAT) project which offered nationwide continuing vocational training (CVT) for teachers in beauty and hair care to be further disseminated in vocational secondary education. The development of occupational skin diseases is one of the most important health risks related to the exposure to chemical and physical risks in hairdressing. The prevention of occupational skin diseases is the overall aim in European countries. The aim of the HIKAT project was to increase hair and beauty care teachers' skills to guide students - future professionals - to work safely. Another aim was to increase teachers' knowledge and help them develop good practices in their own work. The studies in the project were based on the Learning by Developing (LbD) model as part of students’ competence development. Laurea University of Applied Sciences created the LbD model based on authenticity, partnership, experiential learning, creativity and research. Learning is related to development projects that are genuinely rooted in working life. The project was carried out in two phases mainly as blended learning and on-line. The studies were based on a theoretical approach – using literature, written assignments, lectures and group work. In addition, the participating students practically developed the theoretical background, first testing the pedagogical methods and then adopting the best practices into their own work. Assignments were designed so that they were transferred directly to the participating teachers' own classroom. Materials and tools were integrated into the vocational schools’ practical teaching, so that the pupils created practical exercises relevant to their future occupation. Participating teachers also compiled portfolios, which were presented at the end of the studies. The studies were performed in four modules. The students were allocated to four groups that reflected on and shared on-line experiences of the assignments. The topics of the modules were 1) Cosmetic ingredients, cosmetics legislation, microbiology, and allergenic ingredients 2) Occupational skin and respiratory diseases and allergies 3) Ergonomics and safety of the workplace 4) Promotion of workability and health through healthy lifestyle. The students’ experiences were collected using feedback questionnaires after each module and at the end of the project. 25 completed the studies of 20 credits. The opportunity to act as developers in the work environment supported the teachers’ professional competence development. By working in a blended learning environment and co-operating with other professional groups in the haircare and beauty sector, the teachers created new operation models and demonstrated them to their peer students and work community. In the feedback and discussions several teachers reported that the developments in the project were disseminated and adopted widely as new practices in their vocational schools. Portfolios and a project summary presented the strong development of occupational and cognitive competence, especially in the field of work safety and wellbeing. One of the main results from the educational institutional point of view was the successful combination of three different levels of education: vocational school, university and research institute. This led to the synthesis of expertise which was directly disseminated to vocational education students

Hius- ja kauneudenhoitoalan terveyshaittojen ehkäisy : Ammattiopettajien täydennyskoulutus

Työterveyslaitoksen asiantuntijat ja Laurea ammattikorkeakoulun lehtorit toteuttivat Opetushallituksen rahoituksella hius- ja kauneudenhoitoalan ammattiopettajien ’Hius- ja kauneudenhoitoalan terveyshaittojen ehkäisy’ (HIKAT) täydennyskoulutuksen. Hankkeessa (2015–2016) kehitettiin hius- ja kauneudenhoitoalan ammatillisten oppilaitosten opettajille täydennyskoulutus, jossa työterveyteen, työkykyyn ja työturvallisuuteen liittyvää materiaalia ja työkaluja liitettiin osaksi käytännön opetusta ammatillisissa oppilaitoksissa

Työterveyttä kosmetologeille

Laurea Ammattikorkeakoulun lehtorit ja Työterveyslaitoksen asiantuntijat toteuttivat Opetushallituksen rahoituksella hius- ja kauneudenhoitoalan ammattiopettajien ’Hius- ja kauneudenhoitoalan terveyshaittojen ehkäisy’ (HIKAT) täydennyskoulutuksen

Documentation of comorbidities, lifestyle factors, and asthma management during primary care scheduled asthma contacts

Abstract Systematically assessing asthma during follow-up contacts is important to accomplish comprehensive treatment. No previous long-term studies exist on how comorbidities, lifestyle factors, and asthma management details are documented in scheduled asthma contacts in primary health care (PHC). We showed comorbidities and lifestyle factors were poorly documented in PHC in this real-life, 12-year, follow-up study. Documented information on rhinitis was found in 8.9% and BMI, overweight, or obesity in ≤1.5% of the 542 scheduled asthma contacts. Of the 145 patients with scheduled asthma contacts, 6.9% had undergone revision of their inhalation technique; 16.6% had documentation of their asthma action plan. Screening of respiratory symptoms was recorded in 79% but nasal symptoms in only 15.5% of contacts. Lifestyle guidance interventions were found in <1% of contacts. These results, based on documented patient data, indicate a need exists to further improve the assessment and guidance of asthma patients in PHC